Products

Self-funding is an effective financial tool employers use to manage employee health plan costs. It allows flexibility in plan design and lower overall expenses, as well as tax and legal advantages typically not found in fully-insured employee benefit plans.

Employers purchase Medical Stop Loss Insurance for financial protection against individual catastrophic claims and/or a high frequency of smaller claims. The type and level of Medical Stop Loss Insurance purchased should reflect the employer’s size, cash flow and risk tolerance.

Spectrum offers a variety of Medical Stop Loss Insurance products for single employer groups with as few as 15 employee lives. Total paid claims and and shock loss experience is required on all currently self-funded groups, as well as all fully-insured groups over 100 employee lives. Fully-insured groups of 15 to 100 employee lives must provide total paid claims and shock loss experience when available; when unavailable, manual stop loss proposals can be issued.  On all cases where total paid claims and shock loss experience is unavailable, Plan Participant Disclosure Statements are required as a part of the sold-case disclosure and final underwriting process.

Specific Stop Loss – Protection against the financial risk of a catastrophic claim in excess of an individual specific retention applicable to each plan participant.

  • Minimum Specific Retention: $10,000
  • Lifetime Maximum: Unlimited (lower limits available)
  • Contract Basis: 12/12, 12/15, 12/18, 12/24, 15/12, 24/12 & Paid
  • Coverage: Medical (standard); Rx (optional)
  • Specific Advance Reimbursement: Standard
  • Aggregated Specific Retention: Optional
  • Specific Terminal Liability: Optional
  • “No Laser Renewal / Renewal Increase Maximum”: Optional

Aggregate Stop Loss – Protection against the financial risk of a large accumulation of claims that fall below the specific retention and are in excess of an annual aggregate retention on the plan as a whole.

  • Standard Attachment Point: 125% of expected claims
  • Aggregate Limit: $1,000,000 ($2,000,000 available)
  • Contract Basis: 12/12, 12/15, 12/18, 12/24, 15/12, 24/12 & Paid
  • Coverage: Medical (standard); Rx, Dental, Vision and WDI (optional)
  • Monthly Aggregate Accommodation: Optional
  • Aggregate Terminal Liability: Optional

Integrated Stop Loss – Protection against the financial risk of claims in excess of an accumulating monthly integrated aggregate retention applicable to the plan as a whole.

  • Integrated Aggregate Limit: Unlimited
  • Claim Limit Per Participant: Unlimited (lower limits available)
  • Contract Basis: 12/12, 12/15, 12/18, 12/24, 15/12, 24/12 & Paid
  • Coverage: Medical (standard); Rx, Dental, Vision and WDI (optional)
  • Integrated Terminal Liability: Optional